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The comparison between the different generations of autologous chondrocyte implantation with other treatment modalities: a systematic review of clinical trials.

Abstract

PURPOSE

This paper aims to review the current evidence for autologous chondrocyte implantation (ACI) generations relative to other treatment modalities, different cell delivery methods and different cell source application.

METHODS

Literature search was performed to identify all level I and II studies reporting the clinical and structural outcome of any ACI generation in human knees using the following medical electronic databases: PubMed, EMBASE, Cochrane Library, CINAHL, SPORTDiscus and NICE healthcare database. The level of evidence, sample size calculation and risk of bias were determined for all included studies to enable quality assessment.

RESULTS

Twenty studies were included in the analysis, reporting on a total of 1094 patients. Of the 20 studies, 13 compared ACI with other treatment modalities, seven compared different ACI cell delivery methods, and one compared different cell source for implantation. Studies included were heterogeneous in baseline design, preventing meta-analysis. Data showed a trend towards similar outcomes when comparing ACI generations with other repair techniques and when comparing different cell delivery methods and cell source selection. Majority of the studies (80 %) were level II evidence, and overall the quality of studies can be rated as average to low, with the absence of power analysis in 65 % studies.

CONCLUSION

At present, there are insufficient data to conclude any superiority of ACI techniques. Considering its two-stage operation and cost, it may be appropriate to reserve ACI for patients with larger defects or those who have had inadequate response to other repair procedures until hard evidence enables specific clinical recommendations be made.

LEVEL OF EVIDENCE

II.

Links

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  • Authors+Show Affiliations

    ,

    Clinical Investigation Centre, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia. elyzarina07@yahoo.com.

    Clinical Investigation Centre, University Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.

    Source

    MeSH

    Cartilage Diseases
    Cartilage, Articular
    Chondrocytes
    Clinical Trials as Topic
    Costs and Cost Analysis
    Humans
    Knee Injuries
    Orthopedic Procedures
    Transplantation, Autologous

    Pub Type(s)

    Comparative Study
    Journal Article
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    26003481

    Citation

    Samsudin, Ely Zarina, and Tunku Kamarul. "The Comparison Between the Different Generations of Autologous Chondrocyte Implantation With Other Treatment Modalities: a Systematic Review of Clinical Trials." Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, vol. 24, no. 12, 2016, pp. 3912-3926.
    Samsudin EZ, Kamarul T. The comparison between the different generations of autologous chondrocyte implantation with other treatment modalities: a systematic review of clinical trials. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3912-3926.
    Samsudin, E. Z., & Kamarul, T. (2016). The comparison between the different generations of autologous chondrocyte implantation with other treatment modalities: a systematic review of clinical trials. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 24(12), pp. 3912-3926.
    Samsudin EZ, Kamarul T. The Comparison Between the Different Generations of Autologous Chondrocyte Implantation With Other Treatment Modalities: a Systematic Review of Clinical Trials. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3912-3926. PubMed PMID: 26003481.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The comparison between the different generations of autologous chondrocyte implantation with other treatment modalities: a systematic review of clinical trials. AU - Samsudin,Ely Zarina, AU - Kamarul,Tunku, Y1 - 2015/05/24/ PY - 2014/05/16/received PY - 2015/05/15/accepted PY - 2015/5/25/pubmed PY - 2017/4/19/medline PY - 2015/5/25/entrez KW - Articular cartilage KW - Autologous chondrocyte implantation KW - Cartilage repair KW - Knee SP - 3912 EP - 3926 JF - Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA JO - Knee Surg Sports Traumatol Arthrosc VL - 24 IS - 12 N2 - PURPOSE: This paper aims to review the current evidence for autologous chondrocyte implantation (ACI) generations relative to other treatment modalities, different cell delivery methods and different cell source application. METHODS: Literature search was performed to identify all level I and II studies reporting the clinical and structural outcome of any ACI generation in human knees using the following medical electronic databases: PubMed, EMBASE, Cochrane Library, CINAHL, SPORTDiscus and NICE healthcare database. The level of evidence, sample size calculation and risk of bias were determined for all included studies to enable quality assessment. RESULTS: Twenty studies were included in the analysis, reporting on a total of 1094 patients. Of the 20 studies, 13 compared ACI with other treatment modalities, seven compared different ACI cell delivery methods, and one compared different cell source for implantation. Studies included were heterogeneous in baseline design, preventing meta-analysis. Data showed a trend towards similar outcomes when comparing ACI generations with other repair techniques and when comparing different cell delivery methods and cell source selection. Majority of the studies (80 %) were level II evidence, and overall the quality of studies can be rated as average to low, with the absence of power analysis in 65 % studies. CONCLUSION: At present, there are insufficient data to conclude any superiority of ACI techniques. Considering its two-stage operation and cost, it may be appropriate to reserve ACI for patients with larger defects or those who have had inadequate response to other repair procedures until hard evidence enables specific clinical recommendations be made. LEVEL OF EVIDENCE: II. SN - 1433-7347 UR - https://www.unboundmedicine.com/medline/citation/26003481/The_comparison_between_the_different_generations_of_autologous_chondrocyte_implantation_with_other_treatment_modalities:_a_systematic_review_of_clinical_trials_ L2 - https://dx.doi.org/10.1007/s00167-015-3649-x DB - PRIME DP - Unbound Medicine ER -